Q:  Bedwetting & Lithium

My 16 yr old son has been on Lithium since he's been about 11-12 yrs old.  He was diagnosed around 8 yrs old.  He has a history of violence.  Lithium has helped a lot, except lately we're having trouble getting his lithium level back up.  I think it's because we lowered it for a couple of months due to bedtime enuresis.  Actually that's what my question is about.  Does Lithium usually cause bedwetting?  And if it does, is there any way to stop it?  We've tried everything!!  It's affecting his life and our lives a lot.  It affects his self esteem a lot also.  We've been to many doctor's.  Do you have any suggestions? 
 

Dear Lise -- 
You may have heard this already, but are some thoughts to discuss with his doc' (don't try this without that discussion, she could know lots of details that I don't that would decide whether any of these ideas are safe and/or likely to be effective.  One idea is to try having him take the lithium in the morning, then keep well hydrated during the day, until about 5 pm or so, then no more fluids (or very little, just enough to keep from being really thirsty). This presumes that the lithium level is not higher than 0.8, because if it is, then you can't fool around with getting dehydrated without very careful monitoring of lithium levels.  

We know that once-a-day lithium dosing is okay. We also can presume that lithium is causing your son to be thirsty and take on more water, much of which has to get eliminated through urination, as that's pretty standard too. What's not clear is why your son would still be having enuresis at 16, so that has to be looked into independent of the lithium issue, but you're right, I would think lithium could make it worse. You've surely already looked at alternative medications; it might come to that. Good luck figuring it all out. 

Dr. Phelps